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Dr. A. Clark, Pediatrician

Category: Pediatrics

Satisfied Customers: 4437

Experience: 33 years of experience as a general pediatrician in private practice and in pediatric urgent care.

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Dr Clark. My girl is close to 3 weeks old now and sometimes

Resolved Question:

Dr Clark. My girl is close to 3 weeks old now and sometimes I notice some discharge looking stuff on her diaper and some close to her labia. It's not a lot. Just a few spots. Is that normal? What is that?

Hi and thanks for asking for me. I'm happy that you have asked me to assist you with your child and hope that you can benefit from my many years of helping parents like you.

Dr. A. Clark :

This is completely normal and nothing to worry about I assure you.

Dr. A. Clark :

The discharge is due to the estrogen effects on the mucosa in her vaginal canal and uterus and some baby girls can actually have a bloody discharge due to the withdrawal of these estrogens, just as occurs with a menstrual cycle. Obviously this is pretty alarming to parents if they don't know it's normal, as is her discharge.

Customer: It's not bloody but more like gooey white yellowish stuff

Dr. A. Clark :

That is normal and nothing to worry about.

Dr. A. Clark :

It will go away in the next week or so.

Customer: I thought it should go away by now. It will last this long?

Dr. A. Clark :

Absolutely.

Dr. A. Clark :

No worries!

Customer: Thats good. Thanks for your help

Dr. A. Clark :

You are very welcome and I did see you asked me this question in our other chat dialog so you can ignore it.

Dr Clark,why is my baby so restless when sleeping? She doesnt look awake but she's moving her arms and legs like doggy style swimming and making a lot of noises.

Also, she didnt poop at all since Tuesday late afternoon. She used to poop at least twice a day and now nothing. Should I be concerned? Any symptoms I should look for? She's on half breast milk and I top up with similac advanced.

This is pretty normal for babies this age and not a sign that you are doing anything wrong or that she is ill. Most babies don't really settle into a schedule until 6-8 weeks of age so just be patient. You don't need to pick her up at night unless she is awake and hungry.

Also, breast fed babies who also take formula will often have less regular stools but that doesn't mean she is constipated.

I assure you this will not harm her as babies can go 3-4 days between stools. The formula does this to them but is not harmful so you don't need to change anything. Her stools, like the weather here in Texas, can change any time.

My baby uses a silicone Ng tube. They call it nutri-cath feeding tube and they said its good for 30 days. It was put in on aug 10th. We flush it with 1ml of water after every use. However, we notice today the tube is getting a bit yellowish due to the milk residual. Is that ok or normal to use? It's not plugged as we still able to get her stomach acid and milk is still going down.

With just gravity it will take up to an hour to run in. There are pumps that can do it faster but at his age there really isn't a "need for speed" so to speak and a slow drip helps keep her stomach from filling too fast and then causing reflux.

Hi Dr Clark, I notice some pimple looking red spots on the crease of her neck. There're roughly 5 of them and very small. I couldn't see it until she tilt her head all the way back today. What is that and is there anything I need to do to make it go away?

Still nothing to worry about as they are likely bites but not anything other than chiggers or some other small insect. If you are concerned about Rocky Mountain Spotted Fever (RMSF) then don't be as it is from a tick bite.

Dr Clark. With a 3 week old, should we start tummy time now? If so, for how long per session and per day? Should we just lay her on our chest of put her on a flat surface like her crib? Does those activity mats help?

You may place her on her tummy if you like but with the NG tube and her age it really isn't that necessary. Of course, you need to keep a close eye on her at all times while on her tummy since being on her back is the safest position for all babies to decrease the risk of SIDS.

My baby is moving her arms and legs as if she's riding a bike in the air as soon as she's awake in her crib. One time she can move non stop for 30 to 45 mins. Why is she moving around so much? Do we need to stop her if she moves for such a long time? She doesn't seem to be tired at all. She only moves like that when she's in her crib. If we hold her she is much quieter but she still loves to tilt her head and whole body back.

Not a problem at all. Some babies are just more active than others and I'm always pleased to see a newborn who moves all its extremities well and is awake and alert rather than those who just sleep all the time.

Dr Clark, I think my daughter has developed a habit of sleeping on our arms. Because of the lengthy Ng tube feeding. She will fall asleep half way and then when it's time to put her back to crib, she's awake. The only way to make her fall back asleep is to hold her for a while or put her on our bed. Because we're so tired at night, I'm wondering if a cosleeper is a good idea? My husband sometimes hold her while sitting on our bed and he fall asleep. I'm afraid this is very unsafe for her. Will getting a cosleeper and put it in there be safer and better? At least she's beside us.

Not a good idea as this is a habit that is hard to break, both for you and for her. She is old enough to put her down when she is obviously sleepy and let her fuss a bit, even though I know with her past problems and NG tube you really don't want to do this.

We all develop sleep habits or associations; that is, certain noises, level of light, etc that we become accustomed to having around us to allow us to go to sleep quickly. Infants do this as well and sometimes won't sleep without some noise and light in the room, white noise generators, etc.

I suggest you might want to download an ebook version of Dr. Richard Ferber's book: Solve Your Child's Sleep Problems and read the first chapters where he explains sleep physiology as that helps you to understand his methods for "treating" each sleep problem that can arise in childhood. It is not harsh or neglect to let your baby learn "self-quieting" skills, even at her tender age.

Also, Dr. Harvey Karp also has a website about helping children to quiet quickly:http://www.happiestbaby.com/calm-colicky-infants/

The health nurse told me she's too young to let her cry to sleep or cry for long. She said we should hold her if she's too fussy or cry. Is that right? I remember my friend recommended that sheep stuffed animal where it creates white noises. Does that work? Every time we put her back to crib it's like a countdown to 10 she'll cry. She's less fussy in the morning. At night she's wide awake after her meal. When I thought she's in deep sleep. She'll be awake with her eyes wide open when I put her down. For some reason she sleeps better in the pack n play than her bassinet. Is it because the mattress is too firm or the space available for her is not as big?

Nice for her to say that since she's not the one up with her at night! Co-sleeping is not a good idea at all due to SIDS risk but white noise critters are fine. Where she sleeps is not a problem as long as she is on her back.

Dr. Ferber is the world's foremost authority on sleep physiology in children and is a pediatric neurologist too. Take a look at his website:http://www.babycenter.com/0_the-ferber-method-demystified_7755.bchttp://www.childrenshospital.org/views/june06/sleep.html

Yes. It's getting to the point that we're tired and I don't want her to end up sleeping in an unsafe place. Do you think the mattress of her bassinet and the limited space made her doesn't like to sleep there? She likes to sleep in the pack n play a lot more which is almost double the size of the bassinet. She sleeps in the pack n play in the morning and bassinet at night.

I'm just debating if we should try to put her in a crib instead of a bassinet to see if she likes that more. It's much bigger and a little softer mattress. Anything we can do to at least make her sleep on her own for a little whole at night without her crying.

I assure you she can learn to sleep anywhere but the key is being consistent about not picking her right back up and putting her down still slightly awake so she learns that is how she will go to sleep.

We were feeding her this morning and the feeding stopped halfway. We guessed the tube was clogged so we detach the syringe and flushed 1cc of water in her Ng tube and then connect the milk again and the milk continues to flow. The tube has been in for 18 days and they said its good for 30 days. Do we need to rep,ace the tube or as long as its flowing then it's good? We do flush it with water after each feed. The tube said it holds 0.8cc and we flush in 1cc. Do we need to put in more water to prevent it from clogging?

It is still fine as long as it flows freely after flushing. The issue with the tubes is that they over time become discolored and hardened due to the acid of the stomach and not so much the milk flowing through them. I would flush with at least 2-3 cc of water to make sure it is clear after every feeding as that is what the nurses do in the hospital as long as the baby is not being fluid restricted (same with IV medications being flushed after they are pushed).

I guess she doesn't have any fluid restriction as no one mentioned anything. So 2cc of water is not too much? I just read online that people flush it with luke warm water and we've been flushing it with cold sterile water. Not sure if that makes a difference as well.

is it because my baby will aspirate on thin liquid so that's why she sometimes choke on her own saliva? or it's just the NG tube bugging her? I thought babies drool when they are older and not at 4 weeks old.

Seems like my baby is only congested after her 3am feeding not sure why. But last night when she sound congested, I see some milk in her mouth. It should be milk and not mucous. But nothing really came out of her mouth. It's just some milk mixed with her saliva and probably she swallow it after. That was 1.5 hr after her tube feeding. That is not reflux right? So weird she's fairly comfortable the enter day except after the 3am feeding b

She may have reflux as most babies do (spitting IS reflux and always has been!) and the tube sometimes makes it easier to reflux since it allows milk to come up along the tube. As long as she is not choking you need not worry as all babies do this with or without an NG tube.

That or just leave her sitting up in her car or infant seat for a half hour or so. Remember though that spitting (now called reflux) is normal and always has been and there are only two ways it can be a problem: either they are choking on it or spitting so much that they don't gain weight, both of which are rare.

We are thinking about getting the baby bjorn babysitter for her to sleep/sit in it when she's congested. Is that a good one to use? Also, she really likes to arch her back with her head trying to tilt back. Why she always do that? She doesn't look like she's not happy. But no matter holding her or in her bed, she just does that sometimes. Will she have more spit ups if the Ng tube is flowing too fast? We secure the syringe at the same place sitting in the same chair with her everyday. Sometimes it takes a hr. like today it only took 30mins for the seAmount of milk. Not sure what makes the diff.

Is reflux a serious issue or fairly common? I read online and seems like reflux can be a serious issue. I know you mentioned its nothing to worry about. Just hard not to worry as she's our first child and new to this.

All babies spit up and now it is just called by its medical term reflux. It is not serious and the American Academy of Pediatrics now recommends NOT treating babies for reflux unless they are having serious side effects from it (choking, failure to thrive, inflammation of the esophagus, etc.).

Here is the link:http://www.aap.org/en-us/about-the-aap/aap-press-room/pages/Not-all-Reflux-in-Infants-is-Disease-According-to-AAP.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token

Dr Clark. Why my baby is getting quite a few of those pimple looking red spot with white head on her face? It looks like acne but they are very tiny spots. Around 1mm only. Two on her eyelids, some on her upper chin area, one on her forehead and three on her face. It's only on her face. I don't see them anywhere else on her body. Why is that and what should I do with them?

She had some on we nose when born and those are gone now. How come these new one just surfaced in the last day or two? I thought milia are from birth so I was thinking this is more like acne.

Also, my baby doesn't seem to sleep as much and very actively moving around even if her eyes are closed. Seems like she never had any deep sleep the entire day at all. She's very awake during the day but she doesn't sleep for long at night either.

Dr Clark. Yesterday we went back to the hospital to have my baby's NG tube changed as it has been a month. They change from using her right nostril to her left. After the change, she has her sneezing quite a bit. She sneezed at least a dozen times yesterday. Nothing throughout her sleep last night but this morning she's sneezing non stop again. Is it because of irritation or how do I know is she got a cold? She sound congested as usual in the morning.

This is common with NG tubes as they take a few days to get used to and even worse in adults sometimes. Nothing to worry about though as she will forget about it soon. She might have extra mucous in her nostrils for a few day, especially the right one now that the tube is out.

As soon as they removed her tube there's already a bit of mucus coming out. My parents thought she's cold or sneeze because of temp change. I thought once removed, it wouldn't irritate them anymore.

Customer:replied 1 year ago.

Also we always wrap her hands with mittens or with the sleeves to prevent her from pulling the tube out. Will that be a problem as basically her hands are always hidden. When the tube was first put in a month ago she managed to pull it back out within 15 mins. After that the nursery always bundle her. Now that she's home, we try to hide her hands too.

How come she would spit up milk after feeding ever since her tube was changed? Not a lot. Maybe half a teaspoon. She's also moving non stop after feed. Not sure because she's uncomfortable or she's moving too much causing reflux?

Every time the NG tube is moved or replaced it will still stimulate a gag reflex plus remember too what I said about the tube creating a perfect conduit for reflux to occur so spitting is even more common.

Her activity will only increase as she gets older so don't worry that it is due to anything such as pain or causing reflux.

Thanks. Her behavior seems different today so that's why concerned. She's still sneezing non stop. Her face is red whenever she moves. She also cough more today too not sure because of the uncomfort from the tube or choking on her own saliva again. These activities usually happen about a hr after her feeding. Seems like changing the tube makes her so much more uncomfortable this time. Is it because she's older? Last time they changed it when she was 10 days old, none of these symptoms surfaced.

That's just the tube and perhaps her sinuses on the side the tube came out of now draining. Being older does make for more problems in that regard as she is more alert and able to express her discomfort and displeasure.

I'm sure she will settle down soon and just keep now open nostril suctioned as often as you see any mucous or drainage.

If my baby is having reflux, should it be happening every meal? She always seems to be uncomfortable after the 7pm feeding. Moving around and arching her back. If she moves so much then she would cough or have some gasping sound. She is breathing fine. How come it's always this feeding having these symptoms/problem? She's fine every other feeding.

Some babies just have certain feedings or times that they reflux and only occasionally is it due to who is feeding them or their position. Most all babies are fussier during the 4-7 pm time slot so I suspect she is just acting more and more like a normal baby, which is actually a good thing! As long as she's happy otherwise and growing I would not worry.

Maybe your prediction is right. I just can't get her to stop moving while she's feeding. I guess it might be chain reaction that she's moving during her feed so afterwards causing reflux? There's really no way I can pin her down during feed at 7pm.

We want to have a photo session with My daughter prior to changing to a new tube for next month. Can we pull it out at home to air out her face before heading to hospital? It'll me roughly 30 mins after her meal, is that okay? It's simply just pull it slowly out from her nose right?

Hi Dr Clark, when can I stop feeding her in the middle of the night? She now takes 140ml via Ng Tube 6 times a day. I realize she never wakes up for her 3am feeding anymore. I even slept in for a hour today and she's not even awake yet. If in the morning, feedingHer just few minutes late, she'll be screaming like hell. What is your advise? She's 8.5 weeks old now.

As with bottle or breast fed babies, at her age if she is not waking up due to hunger then you can skip that feeding and perhaps increase her feedings the rest of the day. It sounds like she is growing well then if she does not even wake and I know you will enjoy a good night's sleep.

Hi Dr Clark, my baby has been very fussy for the last two days. She was never a crying baby but over the past two days she will cry out of nothing or cry in the middle of the night. Usually she can sleep pretty peacefully throughout the night. How do I tell she's sick or just simply whine and being fussy? She's not crying non stop maybe cry for few mins and then stop. A hr later she'll cry again etc. Also, she's taking 140ml every 4 hours. She's 9 weeks old weighing close to 11.5lbs. Is she eating enough?

She may be ready to increase her feed to up to 160 ml every 4 hours, especially if you have stopped feeding her at night. If she were ill she would have other symptoms such as fever, cough, cold, diarrhea, vomiting, etc. I suspect she might just be hungry so increasing her feeds may help.

Thanks. She just had her 2 months vaccines today. What are some signs I should look for if she's having a fever? I know to check her temp but basically she will be uncomfortable and cry if she's unwell right?

Also, my family physician expressed concerns of having her NG tube in for too long because it might affect her esophagus and damage to throat. She had it for 8 weeks now and won't have her next scheduled study till end of November. What is your opinion on that? She's getting more and more crankier because the feed is gong down so slow (a hr to a hr and a half for 5oz) She takes a oz by bottle and she loves it. She's growing well and there really isn't any indication of a problem other than that swallow study showed aspiration when she was 6 days old. Do you think she has outgrown the problem by now?

Hi Dr Clark, my OT decided to change the honey consistency to nectar to see how she cope with it. Sh was doing great with honey and finish the bottle quite fast. How come it took her almost double the time to finish it and she sound like there's mucus in the throat while eating. Is it because she's nit used to the consistency? She's just tired after her bath? Or she's still aspirating on that?

After feeding her the nectar consistency for the second day now. As you've said above, she's now taking it the same way as before with no sign of distress. She's also taking two oz instead of one. Before she finish one oz of honey consistency around 5 to 10 mins. Now she finish the two oz in 15 mins or so. So does that mean she has improved with her swallowing and with no distress means no aspiration as well?

Do you think it's safe for us to wean her off the tube without doing the swallow study? Our pediatrician, family dr and two OTs all think she should be fine to do another swallow study to see how she's doing now. However, the earliest appointment they can give us is 7 weeks away!!! This is due to lack of government funding. They understand our frustration and suggest to see if we can wean her off the tube step by step by changing consistency and also volume taken by mouth. She was a silent aspirator when she was couple days old. Now she will cough even when choking on saliva. We really want to get rid of this tube asap. How long do you think we need to try on the different consistency? Is 3 days at each stage enough? She went from honey to nectar taking 2oz her feed and she has no problem at all now. Next will be half nectar and then straight milk. I just can't let the "lack of government funding" excuse hinder my baby's health.

I think you can likely progress to a wean to formula on that schedule and as long as she doesn't have any choking or other problems she should be fine. I think the wait is unreasonable but you have to consider also that the tube is not dangerous or harming her and you are transitioning to the bottle.

I suspect she will do fine and then perhaps they will forget the study and remove her tube.

If she choked and coughed around 5 times half a hour after her feed (that's a hour after her oral feed because we tube feed her the rest of the milk after her bottle) is that a sign of any problem? Just want to be cautious as we are experimenting with new feeds. Or only choke and cough DURING a feed us a cause for concern?

We've now gone down to half nectar and she still shows no sign of distress when taking her bottle. The OT suggest to now move forward to increase volume hoping to move up from 2oz oral now to complete oral (6oz) over the course of 10 days and slowly increase one oz every 2/3 days. My pediatrician show a bit of concern to move like this without a swallow study. I'm thinking if she's not showing a sign of distress taking the half nectar for 6 feedings already, she should be okay with it right? I really want to remove her tube as it's really bothering her. If she can switch to complete 6oz half nectar no problem, then we should be good to remove her tube right?

Choking on saliva from time to time NOT during feeding is normal right?

I'm with you that in the face of the unavailability of the swallow test any time soon the course you are taking is quite reasonable. You don't need a swallow study to know if she is choking, it only confirms it. I say just stay on the course you are on now as long as she is not choking or having any other problem, gaining weight, etc. and she will be fine I'm sure and her tube can come out when it is due to be replaced anyway.

Thanks Dr. Clark. One more question, she had two episode of harder stools today. It's not a paste but more pebble like. Is she constipated? She is on the same formula / breastmilk ratio....will the change in consistency of her milk change her bowel movement?

Hi Dr Clark, My daughter has been taking 3oz oral and 3oz tube now and after 6 feeds there's no episodes of distress or coughing during feed. There was once she coughed RIGHT AFTER her feed. I guess that's fine right? We'll proceed with 4oz oral and 2oz tube tomorrow. Once she gets to 6oz oral with no problem for a day, do you think it's okay for us just to remove the tube ourselves?

On another note, the tegaderm tape on her face really irritates her. Recently her face is very red and rough. She always rub it as well. Is it because her face is very itchy? I put the cream that was recommended for diaper rash or anywhere else that's dry and it seem to work. It got worst again after she start rubbing it. What else can we do about it?

I hate to give the order to remove a tube that was placed by her physician so I think you have to make that decision yourself. That said, I would continue to transition her over to all oral feeds as you have planned.

Regarding the Tegaderm, I would wait until she is on all oral feeds and then remove the tape for a day and use paper tape instead, available at a pharmacy. I have to tell you that when nurses remove the Tegaderm or any tape securing the tube it is not uncommon while the tube is unsecured that the nurse, doctor, or even the patient might inadvertently pull the tube out! If this happens and she is already on oral feeds completely then I would not rush her in to have the tube replaced but rather just watch for a couple of days to be sure she is not having any problem with her feedings, choking, etc and then perhaps just leave it out.

Thanks. I'll stop giving her the vit d then. She's on her 10th feed of 4oz oral 2 oz tube and she choked once towards the end of this feed. She coughed three times and she's fine again. No turning color or anything. We burp her and continue to finish the last bit. She just woke up and I can hear her taking very big gulp by the sound of her swallow. Is that a concern.

Great. Gulping is not a problem as all babies reflux a bit and either gulp it back down or spit it up but rarely choke. After feeding her, burping during the feeding, say every ounce, sit her up for 10-15 minutes and then burp her again as this allows the rest of the air to rise in her stomach and makes it easier to burp.

Will having the tube in and feeding orally cause her to have reflux more easily? She coughed twice again during this 5oz feed but again...it's towards the end. My mom didn't burp her at all so she ate close to 4oz non stop before she had that cough. Just like the feed this morning, no change in color, doesn't look stressed. Coughed and she's ready to resume. Of course after the cough we burped her and let her rest for a min or so before we resume her to finish the bottle. She's using premmie nipple so will tiredness also cause her to choke when she's tired and starting to fall asleep? I know a lot of my friends babies do cough during their feed and it's pretty common. I just want to make sure she's fine too as she had that aspiration history when she was few days old. Thanks

We have removed her tube for two days now. She's taking 6oz orally for two days over 10 feeds. She still have that occasional cough during feed. Usually will cough very loud one to three times and she's fine. As you mentioned above no sign of distress and usually we'll continue with her bottle without any problem. Is that ok and is that normal for her to cough? It probably happen in 4 of the 10 feeds where she coughed.

Also one time she started to have hiccups while I was burping her in the middle of her feed. Should I continue to feed or wait till the hiccup stops? I kind of waited for a while and I thought her hiccup stopped and continue to feed but minutes later she coughed.

She may still have some incoordination and I suspect they will want a swallow test at some point if she continues to cough but the OT/PT folks can also show you some exercises to do with her to improve that. I would just keep up what you are doing and it is OK to feed her with the hiccups.

The cough is usually towards the end of her feed where she's starting to fall asleep. We're wondering if the nipple is flowing too slow so cause her to be tired from sucking and falling asleep cause her to choke? It'll take her 35 mins it finish a 6oz bottle with preemie nipple. OT told us to wait a week before changing to regular nipple so she can get more used to a 6oz bottle. She NEVER coughed when she was taking 4oz or less and she can finish those in 15 mins. What do you think? With her coughing one to three times is not a major concern right?

Why don't you switch to a regular nipple or a Nuk nipple to see if that helps. Also, if the nipple has been washed many times they get "gummy" and don't flow as well. If you hold a bottle upside down and the milk does not drip almost faster than you can count it then replace it.

For her size 6 ounces is fine but no more often than 4 hours as she may just be overflowing a bit.

She's taking 6 oz 5 times a day. Not more often than 4 hrs. My paediatrician increased her feeds when we start skipping her night feeding. So feeding her when she's tired out also can cause her to choke too?

Not necessarily because she's tired but she may be swallowing a lot of air if the nipple doesn't flow well. Try some other nipples just to see but her intake is exactly what she needs for her weight so she, and you, are doing great!

changed to regular nipple as per your suggestion and she coughed twice during her feed. She cough twice both times. No change in color, no change in breathing and no spit up or vomiting. is it because she's not used to the nipple? But she finish the bottle within 25 mins. I'm just getting concerned about her coughing although my entire family thinks her little cough is nothing out of the ordinary.

also she was trying to poo at the same time she's drinking...not sure if that makes a difference as she always make "sound" when she's pooing and she coughed after. She does look fairly peaceful after her feed and never show signs of "trouble".

Why she sounds like she got quite a bit of phlegm or mucus in her throat?

Sounds fine to me but if you want take a short video of her eating and try to catch one of these coughs. Then send it to me. You may have to start a new questions series with chat but directed to me by name (this one is getting kind of long but I don't mind!). In chat it is easy to attach files and that way I can actually see what you are seeing and tell you what I think.

Okay. Will do. Maybe next time I'll just start a new question and direct it to you. Just I thought would be easier you have the history here but I guess by now you already remember who we are! Not sure if I'll be able to catch her cough...will try.

Why she sounds like she got quite a bit of phlegm or mucus in her throat?

I feel like we are old friends by now!! Just make sure you ask for me by name and if anyone else replies just ignore them. All babies have mucous drainage, gurgle, etc when they eat so I really doubt there is anything going on to worry about.

I will tell you that...the things you have to go through to be an Expert are quite rigorous.

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Dr. Yogindra Vasavada

Pediatrician

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M.D.(ped) passed at first attempt, in practice continuously for last 37 years. Certi. in Comp

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